Infection control was improved when hospital ICU patients were washed daily with chlorhexidine-soaked washcloths in a randomized trial, researchers reported.

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Infection control in hospital ICU patients was improved when patients were washed daily with chlorhexidine-soaked washcloths in a randomized trial.

Point out that patients treated with chlorhexidine had significantly lower rates of hospital-acquired bloodstream infections than those washed with non-antibacterial cloths, and bathing with chlorhexidine was also associated with lower rates of central-catheter-associated bloodstream infection with Gram-positive cocci.

Infection control in hospital ICUs was improved when patients were washed daily with chlorhexidine-soaked washcloths in a randomized trial, researchers reported.

Compared with non-antibacterial washing, the wipedowns with chlorhexidine washcloths associated with a 23% lower rate of multidrug-resistant organism acquisition (P=0.03), according to Michael Climo, MD, of the McGuire Veterans Affairs Medical Center in Richmond, Va., and colleagues.

Bathing with chlorhexidine washcloths was also tied to a 28% lower rate of hospital-acquired bloodstream infections (P=0.007), they wrote in the Feb. 7 issue of the New England Journal of Medicine.

The antiseptic agent chlorhexidine gluconate is effective against a broad-spectrum of organisms and "has residual antibacterial activity, which may decrease the microbial burden on patients' skin and prevent secondary environmental contamination," they noted.

The authors also noted that prior research had shown chlorhexidine bathing was tied to possible prevention of bloodstream infection and multidrug-resistant organism acquisition.

The further test this association, the researchers carried out a multicenter, cluster-randomized, nonblinded crossover study of daily bathing with chlorhexidine in 7,727 patients in intensive care or bone marrow transplantation units.

It took place in nine such units in six hospitals. Units were randomized to wash all patients either with no-rinse 2% chlorhexidine-soaked washcloths or non-antimicrobial washcloths over 6 months.

Each unit then switched over to the other method of patient bathing for the next 6 months.

The participants were monitored for bloodstream infections and multidrug-resistant organisms over the 2 days following each bathing period. Rates of infection and organism acquisition were measured during this time.

Patients were actively monitored for vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) during the study. Those colonized with either bug "were placed on contact precautions once test results became available," the researchers indicated. The same precautions were instituted immediately on admission for those with a history of colonization or infection.

Researchers also recorded unit characteristics, unit type, mean length of stay, rate of use of central venous catheters, median patient age, distribution of patient sex, monthly rate of incident and prevalent MRSA colonization or infection, monthly rate of incident and prevalent VRE colonization or infection, and infection with MRSA or VRE at time of admission.

Among those treated with the non-antibacterial wash, there were 165 new cases of MRSA or VRE versus 127 among those washed with chlorhexidine, for a rate of 6.10 versus 5.10 per 1,000 patient-days (P=0.03).

Additionally, patients treated with the chlorhexidine wash showed a trend toward a lower overall rate of VRE acquisition, 3.21 versus 4.28 in the control group (both per 1,000 patient-days, P=0.05).

There was a nonsignificant difference in the rate of MRSA acquisition between chlorhexidine and non-antibacterial groups during that period (1.89 versus 2.32 cases per 1,000 patient-days, respectively, P=0.29).

Overall risk over time in a Kaplan-Meier analysis was also significantly lower for chlorhexidine-bathed patients (P=0.02).

The differences in risk of bloodstream infection was more pronounced among patients who were in the intensive care unit longer, they noted. Those who were in the intensive care unit for more than 7 days and bathed with chlorhexidine had a relative risk of 0.69 for primary bloodstream infection (95% CI 0.47 to 0.99).

Bathing with chlorhexidine was also associated with lower rates of central-catheter-associated bloodstream infection with Gram-positive cocci, but not significantly reduced rates of fungal infection.

Both treatments were generally well-tolerated, with only 208 skin reactions among patients (78 of those initially treated with chlorhexidine versus 130 of those initially treated with non-antibacterial cloths). Some 85% of skin reactions were mild to moderate.

They concluded that the wash offered a simple, cost-effective, and safe strategy for preventing healthcare-associated infections, colonizations, and bug acquisition.

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